Cynthia M. Westerhout, MSc and Eric Boersma, PhD
From the Department of Cardiology, Erasmus Medical Centre,
Rotterdam, The Netherlands and the University of Alberta, Edmonton, AB, Canada.
The introduction of balloon angioplasty in the early 1980s and stents in the mid-1990s has revolutionized mechanical reperfusion therapy in patients with stenotic coronary arteries.1,2 In fact, percutaneous coronary interventions (PCI) are one of most frequently performed procedures, with more than 1.3 million performed worldwide in 1999.3 However, an important limitation of PCI is the risk of inducing platelet aggregation. As a result of the disruption of the culprit plaque and injury to the coronary vessel during the procedure, the periprocedural risk of reocclusion of the vessel and myocardial infarction (MI) is high, and there is a 20-40% incidence of restenosis at 6-12 months after the index procedure.3
In an attempt to reduce the risk of these complications, several new strategies have been explored. Glycoprotein IIb/IIIa receptor inhibitors (GPIs), for example, have been enthusiastically tested in over 25,000 patients undergoing PCI over the last decade (Table 1). Gp IIb/IIIa receptors are found in great abundance on the surface of platelets and blocking these receptors obstructs the final common pathway leading to platelet aggregation.